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PLASTIC RECONSTRUCTIVE AND REGENERATIVE SURGERY

Abstract

Background - Patients’ demographic and epidemiological characteristics, local variations in clinicians’ knowledge and experience and types of surgery can influence peri-operative transfusion practices. Sharing data on transfusion practices and recipients may improve patients’ care and implementation of patient blood management (PBM).
Materials and methods - This was a multicentre, prospective, observational, cross-sectional study that included 61 centres. Clinical and transfusion data of patients undergoing major elective surgery were collected; transfusion predictors and patients’ outcomes were analysed.
Results - Of 6,121 patients, 1,579 (25.8%) received a peri-operative transfusion. A total of 5,812 blood components were transfused: red blood cells (RBC),fresh-frozen plasma and platelets in 1,425 (23.3%), 762 (12.4%) and 88 (1.4%) cases, respectively). Pre-operative anaemia was identified in 2,019 (33%) patients. Half of the RBC units were used by patients in the age group 45-69 years. Speci?c procedures with the highest RBC use were coronary artery bypass grafting (16.9% of all units) and hip arthroplasty (14.9%). Low haemoglobin concentration was the most common indication for intra-operative RBC transfusion (57%) and plasma and platelet transfusions were mostly initiated for acute bleeding (61.3% and 61.1%, respectively). The RBC transfusion rate in study centres varied from 2% to 72%. RBC transfusion was inappropriate in 99% (n=150/151) of pre-operative, 23% (n=211/926) of intra-operative and 43% (n=308/716) of post-operative RBC transfusion episodes. Pre-operative haemoglobin, increased blood loss, open surgery and duration of surgery were the main independent predictors of intra-operative RBC transfusion. Low pre-operative haemoglobin concentration was independently associated with post-operative pulmonary complications.
Conclusions - These findings identified areas for improvement in peri-operative transfusion practice and PBM implementation in Turkey.

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Authors

Dilek Unal Department of Anaesthesiology and Reanimation, University of Health Sciences Diskapi Yildirim Beyazit Teaching Hospital, Ankara, Turkey

Yesim Senayli Department of Anaesthesiology and Reanimation, “Ankara Gulhane” Teaching Hospital, Ankara, Turkey

Reyhan Polat Department of Anaesthesiology and Reanimation, University of Health Sciences Diskapi Yildirim Beyazit Teaching Hospital, Ankara, Turkey

Donat R. Spahn Institute of Anaesthesiology, University of Zurich and University Hospital Zurich, Zurich, Switzerland

Fevzı Toraman Department of Anaesthesiology, “Acibadem Mehmet Ali Aydınlar” University School of Medicine, Istanbul, Turkey

Neslıhan Alkis for the Turkish Society of Anaesthesiology and Reanimation Patient Blood Management Group and the Turkish National Perioperative Transfusion Study Investigators (the collaborators are listed in the Appendix 1); Department of Anaesthesiology and Reanimation, Ankara University Medical Faculty, Ankara, Turkey

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